Electroconvulsive therapy (ECT) has a lot of negative associations in the mind of the public. When most people think of ECT, they think of mental patients receiving this treatment without their consent in the 1950s (Scientific American). It would probably be terrifying to imagine a treatment involving electricity running through your head. Staff at mental hospitals used this treatment as a means of controlling patients, not always because they thought it would help the patient. In addition, the doses of electricity were very high, and patients were not put under anesthesia. ECT seems like such an intense treatment, which is why a majority of the public would advocate against its use. However, clinicians who treat severe psychological disorders know that ECT is effective when it is used properly.
Modern ECT has made many improvements from the past. Firstly, ECT is done under anesthesia- that’s a lot of progress. Electrodes are placed on the head at specific locations depending on the patient’s specific needs (Cleveland Clinic). During the procedure, small, short, controlled electric currents are passed through the brain. They cause a seizure. During seizures, the electrical current in the brain causes neurons in the specific brain area to activate and fire rapidly. ECT seizures can be from 0.5 to 1.5 minutes, and if they are longer, physicians administer an injection to stop the seizure. The patient is in a controlled environment to ensure that no damage occurs to the head during the seizure. After the seizure, physicians watch to make sure the patient wakes up from anesthesia without problems. Most patients are fully awake after 15 minutes and can walk around within 30 minutes of the completion of ECT. ECT sessions usually occur 2 times a week for 3 to 6 weeks to get the full benefits from the procedure.
ECT is used mostly in cases of severe depression. If a patient with a depressive disorder cannot find another treatment that works (medication or behavioral therapies), then ECT may be recommended. The seizures from ECT allow brain functions to reset. However, the reason why “resetting” the brain improves depression symptoms is still unclear. In very severe cases of depression, the patient has a low quality of life. They most likely are not functioning in day-to-day activities, may spend most of their time in bed, may skip meals, and may have suicidal ideation. Rapid treatment is necessary to help those who have the most severe cases of depression. For severe illness, ECT is 80-95% effective (McLean). ECT can be a lifesaver in these extreme cases, which is why it continues to be recommended. For milder cases of depression, other treatments are used. ECT may also be used to treat bipolar depression or catatonia, but only when no other options work. Repeated ECT is only recommended for those who show improvement after the first treatment.
While ECT is beneficial, it does have side effects that need to be considered. Memory loss is the most common side effect (Mind). Retrograde amnesia causes patients to forget events closest in time to treatment, but it may extend to forgetting events from months or years prior (JAMA Psychiatry). Immediately after treatment, it becomes difficult to retain new information (indicating anterograde amnesia), but for most patients memory will return to normal with time. Some immediate side effects of the treatment include headaches, confusion, drowsiness, nausea, muscle aches, and loss of appetite. Long-term side effects are less known. However, some patients may have long-term memory loss, or have difficulty focusing. The effect of ECT on memory is not quite understood. The events lost due to retrograde amnesia may come back with time for some patients.
Overall, ECT is a very beneficial treatment in the cases of severe mental illness. The stigma around ECT is not warranted. It can be life-saving for many individuals, and the general public should be aware of the benefits of this treatment for those with severe mental illness.